W239 – Periodic health visit
OHIP Neurology Code — INTERNAL AND OCCUPATIONAL MEDICINE (13) · Schedule of Benefits
A periodic health visit (including a primary or secondary school examination) is performed on a patient, after their second birthday, who presents and reveals no apparent acute physical or mental illness. The service must include an intermediate assessment, a level 2 paediatric assessment or a partial assessment focusing on age and gender appropriate history, physical examination, health screening and relevant counselling. This service is for non-emergency in-patients in a long-term care institution, rendered by a specialist in Internal and Occupational Medicine.
When to Use
- Use W239 for annual wellness examinations of non-emergency, long-term care patients when no acute physical or mental illness is present.
- Use this code for routine school-aged physicals conducted by an Internal or Occupational Medicine specialist within an institutional setting.
Common Pitfalls
- Claiming W239 more than once per 12-month period per patient per physician will result in automatic rejection.
- Billing W134 within six months of a W239 claim is a common audit trigger and will be rejected by the Ministry.
- Attempting to use W239 for patients under the age of two is invalid and will lead to claim denial.
Billing Tips
- Ensure the patient is documented as a non-emergency in-patient in a long-term care institution to satisfy the specific eligibility criteria for this specialist code.
Effective: June 1, 2025
A. Consultations and Visits
INTERNAL AND OCCUPATIONAL MEDICINE (13)
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
Performed on a patient after their second birthday.
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